The Health Plan Specialist II is responsible for managing all inquiries from active, terminated, and prospective members of Medica. The Health Plan Specialist II is a primary contact for members to resolve service problems for claims, enrollment, billing, pharmacy as well as interpreting contracts and explaining benefits. They are responsible for exceptional levels of service satisfaction, providing quality service, and the service recovery process. The service recovery process is critical to the success of the department. The Health Plan Specialist II will use this process to assist members in complex situations.
The degree of client satisfaction and retention Medica achieves with membership is directly related to the success of the customer service teams. The Health Plan Specialist II is responsible for identifying, researching and resolving member and all other internal and external customer concerns, problems and issues in a timely and courteous manner. Health Plan Specialist II’s are expected to work with enrollment, billing and other departments within Medica to resolve member issues.
The Health Plan Specialist II’s typically interact with a number of external and internal customers. External customers include the following: active, terminated, and prospective customers (providers and third-party administrators). Internal customers include: employees in medical management, enrollment, billing, claims, sales/marketing and legal. Outside vendors may include: pharmacy benefits managers, behavioral health and dental providers.
Team Representation and Peer Support
Associate’s degree or equivalent work experience required; Bachelor’s degree preferred.
1+ years customer service experience required
Skills and Abilities:
The Customer Service department’s leadership is very focused toward the common goal of delivering high quality service to Medica’s members. The department encourages team interaction and support of each other in dealing with customer issues.
Excellent verbal and written communication skills
Advanced ability to multi task and manage time efficiently is needed.
Ability to identify process improvements, provide mentor and peer feedback and develop knowledge of multiple products and platforms is required.
Demonstrated ability to learn quickly and respond well to a rapidly changing industry and operational environment.